What’s Ahead: This Week

Notable Policy Events

  • Monday, October 22
    • Health Care Payment Learning and Action Network (LAN), “2018 Fall Summit.” Additional information: https://bit.ly/2yQM02S
    •  The GreenHouse Group, “Women in Tech: Securing Medical Devices and Health Records.” Additional information: https://bit.ly/2J8YlEv
  • Monday, October 22 – Tuesday, October 23
    • Medicaid Health Plans of America (MHPA), “MHPA Annual Conference: Medicaid – The Great Debate.” Additional information: http://bit.ly/2R5dN7n
  • Tuesday, October 23 – Wednesday, October 24
  • Wednesday, October 24
    • American Medical Association (AMA), “Effects of Payment Models on U.S. Physician Practices.” Additional information: http://bit.ly/2R8gTYp
  • Thursday, October 25
    • Kaiser Family Foundation (KFF) and National Association of Medicaid Directors (NAMD), “What Are the Latest Trends in Medicaid?” Additional information: https://bit.ly/2CSDd5h
  • Thursday, October 25 – Friday, October 26
    • Medicaid and CHIP Payment and Access Commission, “October Public Meeting.” Additional information: http://bit.ly/2P9f5AR


Weekly Wrap-Up: Notable Health Care Developments From Last Week

 ACA Implementation –

  • On October 19, CMS announced that it has detected anomalous activity in the Federally Facilitated Exchanges Direct Enrollment Pathway for agents and brokers, and estimates that approximately 75,000 individual files were accessed. Press release: https://go.cms.gov/2q5hm1K

 Medicaid –

  • On October 15, CMS announced that Mary Mayhew will serve as the new director of the Medicaid and CHIP programs within CMS. Ms. Mayhew previously served as Maine Gov. LePage’s health commissioner.
  • Also on October 15, Arkansas announced that it will disenroll an additional 4,109 individuals from Medicaid due to their failure to demonstrate compliance with the state’s work requirements. Report: http://bit.ly/2q1P3Bu
  • Also on October 15, U.S. Government Accountability Office (GAO) released a report finding that low-income adults in states that expanded Medicaid generally reported better access to health care than low-income adults in non-expansion states. Summary with link to report: https://bit.ly/2QSqvpS
  • On October 16, HHS Office of Inspector General (OIG) released a report finding that states follow a common framework in responding to Medicaid breaches of data, and recommended that CMS reissue guidance to states about reporting such breaches to the agency. Summary with link to report: https://bit.ly/2Pd1N6k

 Payment and Delivery System Reforms –

  • On October 17, CMS released the Rural Community Hospital Demonstration’s Report the Congress, finding that participation was associated with increases in Medicare payments for inpatient services, helping to improve participating hospitals’ financial health, but had little impact on quality for Medicare beneficiaries. Report: https://bit.ly/2S3vOV8

 Drug Prices and Regulation

  • On October 15, CMS issued a proposed rule that would require prescription drug manufacturers to post the Wholesale Acquisition Cost (WAC) for drugs covered in Medicare or Medicaid in certain direct-to-consumer (DTC) television advertisements. Comments are due by December 17. Press releases: https://go.cms.gov/2Pz2kMX and https://bit.ly/2IZn660 CMS Administrator Verma statement: https://go.cms.gov/2OzLhhh Proposed rule: http://bit.ly/2R01wRI
  • Also on October 15, Food and Drug Administration (FDA) released two new guidance documents related to modernizing drug development, improving efficiency, and promoting the innovation of targeted therapies. FDA Commissioner Gottlieb statement: https://bit.ly/2ChMN08
  • On October 16, FDA released draft guidance on presenting quantitative efficacy and risk information in DTC advertisements. Comments are due by December 16. Guidance: http://bit.ly/2R87Bvz
  • On October 18, FDA Commissioner Gottlieb posted a blog touting FDA’s proposal to harmonize the global scientific and technical standards for generic drugs. Blog: https://bit.ly/2CU130r

 Military & Veterans’ Health –

  • On October 18, Department of Veterans Affairs (VA) announced that results from a recent VA job satisfaction survey showed a general trend of improving employee morale. Press release: https://bit.ly/2EwiLso

Health IT –

  • On October 15, HHS Office of the National Coordinator for Health IT (ONC) announced it had reached an agreement with a health insurer to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security rules. Press release: http://bit.ly/2P8K7Jg
  • On October 16, ONC and HHS Office for Civil Rights (OCR) announced an update to the Security Risk Assessment (SRA) tool for small- to medium-sized practices, which includes new features and improved functionality. Press release: https://bit.ly/2yRE15F
  • Also on October 16, FDA and Department of Homeland Security (DHS) announced a new partnership focused on increasing the coordination of responses to medical device cybersecurity threats. Press release: https://bit.ly/2EB1EWe

 Social Determinants –

  • On October 15, HHS released a report including findings from interviews and case studies on addressing social determinants of health needs of dually-enrolled beneficiaries in MA plans. Abstract: https://bit.ly/2NPPYhO Report: https://bit.ly/2J7gORH
  • Also on October 15, HHS released a qualitative study of perspectives on current practices among top vendors with respect to incorporating social determinants of health in electronic health records. Abstract: https://bit.ly/2yPds1e Report: https://bit.ly/2OsVYSW
  • Also on October 15, HHS released a request for information (RFI) on provider and health plan approaches to improve care for Medicare beneficiaries with social risk factors. Responses are due by November 16. RFI: http://bit.ly/2PcCwcB

 Hurricane Michael –

  • On October 18, HHS activated aid for uninsured Floridians needing medicine in the aftermath of Hurricane Michael through the Emergency Prescription Assistance Program (EPAP). Press release: https://bit.ly/2QZSnbK


  • On October 16, Office of Management and Budget (OMB) published its Fall 2018 Unified Agenda, which included 188 HHS rules listed as administration priorities. HHS and CMS Press releases: https://bit.ly/2J5bxds and https://go.cms.gov/2P98Z3y Agenda:  https://bit.ly/2vIJI2G
  • Also on October 16, Centers for Disease Control and Prevention (CDC) released data finding that total fertility rates fell in the U.S. for both rural and metropolitan counties between 2007 and 2017. Data: http://bit.ly/2R43CA0
  • On October 18, HHS announced $293 million in awards to primary health care clinics and students through the National Health Service Corps (NHSC) and Nurse Corps programs. Press release: https://bit.ly/2yoV2F0
  • Also on October 18, HHS released updates to the Medical Expenditure Panel Survey-Insurance Component Chartbook, a comprehensive annual update of private, employer-sponsored health insurance in the U.S., which finds that premiums for employer-sponsored health insurance ranged from $6,368 for single coverage to more than $18,000 for family coverage in 2017. Summary with link to report: http://bit.ly/2PdlaMA
  • On October 19, HHS released the 2018 update to the National Plan to Address Alzheimer’s Disease. Report: https://bit.ly/2yr6QXf